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them infected food. The Commission does not believe in the existence 

 of a true primary plague septicaemia and its report states with reference 

 to this subject: 



"Primary plague septicaemia probably does not exist. At least our own 

 Commission as well as the Austrian one, and other investigators, have 

 found on post-mortem examination, in such cases in which the portal of 

 entrance of the virus could not be ascertained, small hemorrhagic glandular 

 foci, or a focus in the lung. These had in consequence of the indifference 

 of the patients or in consequence of their occult location, escaped notice 

 during life. Hence plague septicaemia is not a special type of the disease, 

 but the generalization of a primarily local process. That it may then 

 again lead to other secondary internal foci we have demonstrated in a 

 case of plague meningitis." 



Septicopj-emic processes with pus metastasis, the commission 

 believes to be due to a mixed infection, as is also the case in 

 purulent abscess formation of the plague bubo. From this condi- 

 tion the commission separates a puriform softening of the bubo 

 without abscess formation, which may occur in pure plague infection 

 without the presence of other micro-organisms. The pathologic 

 anatomy is described as follows : 



The bubo is anatomically a larger or smaller tumor, which contains 

 one or more enlarged lymph glands; these are rarely greater than a 

 pigeon's egg. They are united into one mass by either oedematous or 

 hemorrhagic connective tissue. The glands and the surrounding tissue 

 show all degrees of inflammation, from simple medullary swelling to oedema- 

 tous infiltration, bloody infraction, suppuration, and complete necrosis, 

 according to the intensity of the process, the duration of the disease, and 

 the single or multiple microbic infection. As is the case with the 

 periglandular tissue, the neighboring fascia, the areolar tissue, the muscles, 

 the sheath of the vessels and the nerves may likewise be included in the 

 oedematous gelatinous or hemorrhagic infiltration; these structures may, 

 as it were, become parts of the bubo. It is not so rare to find a bubo which 

 extends from the inguinal glands to the cysterna chyli, from a cubital gland 

 into the axillary space up to the vena subclavia or from the angle of the 

 maxillae deep into the thoracic cavity. In such extensive cases the periph- 

 eral glands show a milder, the more central ones a more profound degree 

 of inflammation and destruction; while the younger stage of the process is 

 present in the latter, the older one in the former. The anatomical findings 

 in the plague-infected lung can be described with few words. In the lobular 

 form, we generally have quite an extensive process with its favorite seat 

 in the lower lobe. This lobular type of pneumonia is characterized by a 

 peculiar mixture of the different stages of hepatization and by an accom- 

 panying serous catarrh. In the hybrid types in which old tubercular foci 

 and fresh plague infiammatory processes are mixed, the picture becomes 

 still more varied. Twice we saw in croupous foci, necrosis and hemorrhagic 

 infiltration of the center to such an extent that expulsion of larger masses 



